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Prior authorization

Prior authorization by Security Health Plan is required before receiving certain services to ensure coverage and payment for those services. Please have your doctor complete a prior authorization form and submit it to Security Health Plan if you plan to receive any of these services.

When is prior authorization needed?

Security Health Plan requires prior authorization for some medical services or equipment. While a provider will generally make these requests and submit the necessary forms, it is a member’s responsibility to make sure the process is followed. A health care provider may contact Security Health Plan to determine whether a prior authorization is required for a member’s service or medical equipment by calling our Provider Assistance Line at 1-800-548-1224.  

Abdominoplasty Hospice
Air ambulance transport Infuse bone graft
Amino acid formula Lung volume reduction surgery
Autologous cultured chondrocytes MAZE procedure
Cardiac valve replacement Non-affiliated provider request
Clinical trials Non-emergent ambulance transport
Cosmetic and reconstructive surgery Office procedure with site of service request other than in an office setting
Elective inpatient admission including: Oral appliance for obstructive sleep apnea
Medical (acute and behavioral health) Outpatient procedure with site of service request as inpatient setting
Surgical Outpatient therapy treatment (occupational therapy, physical therapy, speech therapy)
Enteral feeding Second opinion
Experimental or investigational services Skin substitute
Fecal transplant Spinal cord stimulation
Femoroacetabular impingement surgery Swing bed admission
Gender reassignment Transplants
Genetic testing TMJ
Hearing aids for members over 18 years of age Elective outpatient procedures such as, but not limited to:
Home health including but not limited to: Carpal tunnel surgery
Skilled nursing Knee arthroscopy
Physical therapy Back surgeries at all levels
Occupational therapy



Durable medical equipment

All services for durable medical equipment and prosthetic-orthotic services will require prior authorization from Northwood, Inc.

Security Health Plan has partnered with Northwood, Inc., to manage all durable medical equipment and prosthetic-orthotic services. Your provider will work with Northwood to ensure that authorizations are in place for products and services you receive. Below are a few services that require prior authorization and need follow-up with Northwood.


Part B drugs

 Part B-covered drugs  known as medical benefit drugs that are  injected or infused while you are getting physician office, hospital outpatient, ambulatory surgical center or home infusion services may require prior authorization. 

These medical benefit drugs may be added or removed from this list quarterly on a calendar year basis. You can also call our Customer Service Department at 1-844-293-9624 to find out what medical benefit drugs require prior authorization.

Home infusion drugs

Some medical benefit drugs are eligible for coverage by home infusion. 

Skilled nursing services that require prior authorization

acute rehabilitation admission
long-term acute care admission
skilled nursing facility admission

High-end imaging services that require prior authorization

For all high-end imaging and radiation oncology services, you will need to work with your provider to receive prior authorization from eviCore healthcare.

For high-end imaging

www.evicore.com
Phone 1-888-693-3211
Fax an eviCore request form (available online) to 1-888-693-3210

For radiation oncology

www.carecorenational.com
Phone 1-888-444-6185